781

THE LANCET.

LONDON : SATURDAY, DECEMBER 26, 1863.

THE ANNUS MEDICUS, 1863.

ANOTHER year of our labours has terminated. To all who

regard the events of the last twelve months in a cosmopolitanspirit many occasions for serious reflection arise. To us, whose

chief sympathies are given to matters affecting the honourand progress of the medical profession and its kindred sciences,it is a matter of less moment what special topic may occupy theattention of diplomatists, or cause statesmen to study the poli-tical horizon with more than ordinary anxiety. We cannot,

however, be altogether indifferent to that which is passingbeyond the precincts of our immediate shores. On our national

as on our physical constitution occurrences from without arecapable of exercising extraordinary influence. In many wayshave these been sensibly felt. The fratricidal wars which for

the last three years have devastated the American continent,have spread their effects beyond the Atlantic. They havereacted on the English capitalists and seriously compromisedthe comfort and happiness of large masses of our manufacturingpopulation. What the potato was in Ireland, cotton has in aless degree proved to be to the strongholds of our industry-asingle product on the fulness of the supply of which the sus-tenance of a large proportion of the population was almostwholly dependent. This being for the time prevented from reach-ing our shores caused throughout large districts a state of mentaldepression and physical deprivation similar to that which in thesister country eventuated in the development of epidemic dis-’ease and all the attendant social disarrangements which a

rapidly growing pauperism exhibits. How this has been borne

and met is a matter of history. It is enough to say that the effectof such an untoward social struggle has not been without its in-struction to the English nation. Its lessons, it is true, have beenwritten in letters of blood. They have notwithstanding been

accepted with a resignation which could only have resultedfrom the deep-rooted conviction existing in the minds of ourcountrymen that from the contentions of a mighty people was

being developed a principle of self-reliance which throughpresent suffering would yet accomplish great results. Without

adopting either side on this momentous struggle, we have readwith curious interest the progress of events, and watched theAmerican future drifting on the ebb and flow of victory withthe same anxiety that men on shore regard some mighty vessel,dismasted and with disabled crew, struggling through a storm.Passing from the American to our neighbouring continent,it cannot be denied that there circumstances at presentexist which demand the best efforts of diplomatists for

their settlement. It is very evident that throughout Europea restless spirit of change and desire for progress have

been developed. In political equally as in social life is

this manifest. The promptings of nationality and the restric-tions of power have, in some districts, ceased to respond. It is

not for us to discuss the relations of Poland to the Russian

empire, or to inquire whether Austria is true to her traditions.To those whose lives are passed in England it matters not ’,whether Prussians appreciate the constitution they are per.

mitted, or Germany will again essay the chimera of its unity.What is it to the medical profession if Italy sighs for the cityof the forum, or France covets the boundaries of the Rhine ?We hear of the aspirations of the one, and curiously contem-plate the waverings of the other. Conscious that in our island

home we live under a sovereign whom we love, and are

governed by laws that we respect, we desire but little change.Could we extend to others the blessings we enjoy, we woulddo so by impressing on their rulers the necessity of permittingto all the exercise of that disciplined freedom which conferson our country more of liberty and less of independencethan is met with in any other State throughout the world.This apparent anomaly is explicable to those who consider themutual reliance which the different classes repose on each

other. On every important occasion is this manifest. When

the great tribulation of December, 1861, fell upon our land,all participated in the sorrow. When during the last yearthe world was invited to our shores, the hostess of our nationclaimed and received our sympathies in her seclusion.Within the last twelve months now drawing to their close,the universal voice has found expression in exuberant con.

gratulations on the marriage of him not the least of whose

claims to our affections is the anticipation that he may proveworthy that honoured Prince well called " ALBERT the Good."The reappearance of her Majesty amongst her people is all

that is required to complete their satisfaction ; and this, weare glad to believe, is an event which may for the future withconfidence be anticipated. The conclusion which this generaland very partial survey of events suggests is one eminentlycalculated to recompense us for the sufferings of the past, toreconcile us to the occurrences of the present, and to fill our

hearts with thankfulness and gratitude for numerous sourcesof happiness and enjoyment permitted and afforded by theglorious constitution under which it is our privilege to live.

Passing from general to particular considerations, we are ledto ask-What has the last year effected for that important sec-tion of the English people known as the medical profession ? We answer-Much; much for its present advantage and

future honour, which the members of our profession will dowell to accept as matter for their reflection. The Medical

Council, which must be now regarded as the legislative censorof the profession, has during the last year had its authorityseverely tried. In issuing suggestions to the several Collegesrespecting a preliminary educational course, It failed to so

commingle advice with authority as to ensure the adoption ofthe one without the exercise of the other. A correspondenceundignified-to use the mildest term-was the result. For a

time the Council fell in professional estimation. Some dissatis-

fied schools proclaimed their right to differ, and so placing theCouncil in the position of advising, as desirable for adoption, acourse which it lacked authority to enforce. This occurrence,

simple as it appears, opened up the great question-Was ad-monition or regulation the scope of authority, to grant whichan Act was passed containing within its clauses more blundersthan any effort of modern legislation? This question remainsfor definite settlement. In directing the provisions of the Actto be enforced against those who continue to practise without

being duly registered, an important inquiry has arisen as towhether registration is or is not obligatory - apoint wellguarded against in the Act as adopted and modified in our colo-nies, where registration is made the test, not of the power to

732 THE ANNUS MEDICUS, 1863.

recover, but of the right to practise. Here the legal decisionshave proved not more satisfactory to the authority of the Councilthan those attendant on its previous educational efforts. The

Council has been more fortunate in its attempts to uphold thehonour of the profession. Unworthy members, whose professionaldegrees ought to have led them to manifest higher principles, have been subjected to its jurisdiction and condemned to profes-sional infamy. The measure of this punishment is, however, in

complete, unless legal incapacity for practice be thereby entailed.It is obvious that this must rest on the interpretation of the clause

Ialready alluded to. The judicial reading of those clauses of the IAct which affect the right of medical practitioners to recover pay- I

ment for professional services places beyond question their power to do so. The greatest claim the Council can advance to the con-fidence of the profession must rest in the efforts to assimilate ’,rival corporations by approximating their several curricula ofstudy to an equal standard of excellence, and so enlisting inthe brotherhood of a common cause all who may be permittedto practise a universal profession. Not the least powerfulantagonism to existing differences in standard of qualificationwill be found in the adoption of a general Pharmacopoeia as thecommon reference of all. We cannot doubt that this Act,equally important in its influence on the community as on theprofession, will receive in the next session of Parliament suchrevision as must render it completely effective for the purposesit was intended to accomplish.

Passing from the Medical Council, to whom we have awardedthe first place in our observations, we are led to regard theRoyal College of Surgeons of England-a body whose influenceand reputation need no adventitious struggles for their esta-blishment. With this time-honoured institution we have felt

it our duty to remonstrate. Our brethren recognised the

justness of our observations, and adopted our suggestions.Monopoly no longer exists. The College Council seats are

now regarded as legitimate objects of ambition which pro-fessional competency and personal character may hope to

attain. The Board of Examiners has not failed to derive

advantages from a contemplation of the example elsewhereafforded, and a just appreciation of the feeling aroused. If the

past year had witnessed no greater triumph than that therebyachieved, we, on the part of the profession, declare that a greatpractical good has been accomplished, and our time not spentin vain.

Not less important in its influence on the general welfare ofour profession are the changes which, during the past year,have been witnessed in the Army Medical Department. The

Royal Warrant of 1861 was deservedly hailed by our pro-fession as the tardy recognition of claims which had too longbeen permitted to rest in abeyance. The medical officers of

both branches of the service had for years tolerated indignitiesand inconveniences which this gracious concession of her Majestypromised to materially mitigate. Scarcely, however, had theybegun to realize the advantages it conferred, when by slow andinsidious steps they were either withdrawn or rendered abor-tive. The result was the arousing a spirit of earnest dissatis-faction, which induced men of high character to retire fromtheir regiments, and caused a sensible difficulty in procuringcandidates to offer themselves for the appointments vacant.

In our criticisms on the Medical Council and the Council of

the College of Surgeons, as well as on the conduct pursuedtowards our military brethren, we have not shrunk from an

avowal of that which we considered the welfare of the profes-sion demanded. The principles and measures we advocatedhave been to a great extent realized or conceded, and we trustto see them completely carried out.Whether, then, we regard the progress of the Medical

Council towards the accomplishment of the objects for whichit was designed-the promotion of the interests and the main-tenance of the honour of our profession, or consider the im-

portant changes in the internal discipline of the College of

Surgeons,-which proclaims its honours to be within the reachof worthy men whose recommendations rest in the confidenceof their brethren,-it must be admitted that new principleshave been practically developed, which in time will exert greatinfluence on our profession.Many social questions involving the exercise of medical dis-

cretion have prominently occupied the public mind during thepast year. First of these was the extensive spread of epidemicdisease. Fever and small-pox claimed numerous victims. The

latter raged with unusual virulence. Compulsory vaccinationtended, in conjunction with other sanitary measures, to checkits progress, but not before extraordinary fatality had resulted.The source of endemic and epidemic fever has received practicalexplanation from the numerous reports of the public officers ofhealth. The wretched condition of the homes of our workingpoor has attracted the deserved notice of the opulent andcharitable. The princely philanthropy of Mr. PEABODY hascaused the matter to be seriously considered. Many plans areproposed by which amelioration in this respect may be

accomplished. The Corporation of London have voted .620,000for a similar purpose to that contemplated by Mr. PEABODY-the improvement of the homes of the working classes, andothers have also undertaken to give a wider extension to thecharitable spirit aroused. More restricted, but not less per-nicious in its operation, has been the overcrowding of work-rooms in which are accustomed to daily assemble the youngfemales of our metropolis, who therein eke out a weary living.A death under peculiar circumstances drew public sympathyto the conditions under which many young lives are sacrificed,and much practical good has been the result. We at the time

freely discussed a question which there is reason to believe at

present engages the serious consideration of the Legislature. Inantagonism to the habits of silent uncomplaining sacrifice towhich so many young females submit, the consideration of thatwhich has been termed the social evil arises. The perniciousinfluence of prostitution, shown in the spread of specific dis-ease, has occupied also a share of public attention. In

garrison towns steps have been taken for its mitigationand control. The importance of measures for such a purposewe readily acknowledge; the difficulty.in their application pre-vents enactments assuming any practical form. We have fullydiscussed this delicate matter, and trust that its ultimate settle-ment is not far distant. The extraordinary spread of infanticide,and the conduct shown to be pursued by a certain class of

undertakers in reference to the disposal of bodies of prematurebirths, have been freely commented on, and an active attentionaroused which cannot fail to diminish the frequency of so greata crime. In addition to legal repressive efforts, a charitableassociation has been formed with a view of assisting the poor

and fallen in the rearing of their offspring, and affording themL opportunities for their support.L Social sanitary questions have arisen in reference to the

733THE ANNUS MEDICUS, 1863.

better ventilation of our middle-class homes and the more effec-

tive drainage of thickly populated districts. Not the least

important of the economic inquiries of the day have sprung froma consideration of the profitable dispoasl of the sewage of townsnow that great central reservoirs are in course of construction.We doubt not that this " mine of wealth," as it has been

termed, will yet be efficiently worked out. Before passing fromsocial sanitary considerations, we may pause to express oursatisfaction at the course adopted by Mr. Alderman WATERLOWin inflicting a sentence of imprisonment rather than fine where

putrid and diseased meat was exposed for sale. This we regardas the only practical means of preventing so grievous an out-

rage on the poor.

Many medico-legal questions of the gravest importance havebeen discussed within the last year. The cases of Fooxs,PpEEDY, BURTON, and more recently that of TOWNLEY, haveled to the investigation of the principles which should guidejudicial rulings where mental disease is pleaded in extenuationof punishment for acts infringing the law. We have endea-

voured, in our estimate of these very difficult questions, toavoid that sympathy which would compassionate crime, andat the same time to prevent the law being perverted to pur-poses which a humane Legislature could never have antici-pated. We believe that the principles we have advocated haveat least tended to the diffusion of just views on importantquestions so intimately affecting our social relationship.The medical profession during the past year has had bitter

experience of courts of law. The cases of RUSSELL v. ADAMS,BROMWICH V. WATERS, and SYMM v. FRASER and ANDREWS,have manifested the present unsatisfactory condition of thelaw as regards the facility with which ruinous actions may beentered on. In each of these three suits, honourable and high.minded members of our profession were subjected to a series ofannoyances and unfounded charges, for the repudiation of

which great outlay of money and waste of valuable time were

required. In each instance the jury unanimously recordeda verdict in favour of the defendants, who, at the expense of

many hundreds of pounds, had to vindicate reputations hithertounassailed. We trust that some means will be devised bywhich a recurrence of similar attempts at extortion will be

prevented, by at least requiring other evidence respecting the

bonafides of the charges made or claims advanced than thatwhich rests in the one-sided statement of those adventurers

who care not how they outrage reputation if they can see achance of pecuniary profit. Amongst members of our profes-sion confidence and good-will have been generally maintained.Some social disagreements did occur, and, it is to be regretted,became public. It is not too much to hope that better feelingwill for the future countenance medical arbitration as the course

most advisable to be pursued in all cases of professional differ-ences.

Many matters of scarcely inferior interest to those we havethus briefly alluded to might well receive consideration on anoccasion such as this. Just now disclosures in reference to in-

human treatment pursued towards imbeciles by their friendsoccupy public attention. We suppose that such are not iso-

lated cases, since a modern novelist of personal veracity hasdrawn similar pictures as from the life, committing, however,the grave mistake of placing their occurrence in institutions re-cognised by law. It is no want of gallantry that prevents ournoticing the discussions which have been revived in reference

to the admission of females to academic degrees. It is not

probable that the matter will ever assume such proportions asto render the scheme formidable to our body. We notice it as

illustrating the eccentric direction which many sensible mindsare occasionally diverted into. Many interesting topics mightbe alluded to in order to show what has been and is intended

to be done in reference to them. On the present occasion itis not requisite to do so. The real question at this period ofself-examination is, has the profession, to whose service we aredevoted, benefited by our labours ?- have its interests and

honour been safe in our hands ?

The progress of medical science in all Its departments hasbeen faithfully mirrored in the pages of this journal. The re-

searches of HUXLEY into one of the most interesting problemswhich has ever engaged the attention of mankind have beenrecorded. The lectures delivered at the Royal College ofSurgeons by that original thinker and unrivalled anatomisthave been given to our readers in a more complete form thanhad ever before been attempted by any journal. Not onlyhave the very words of the lecturer been transferred to our

pages, but the facsimiles of the diagrams and the illustrationswhich he gave have been presented. This form of reportingpossesses the inestimable advantage of making the entire

profession, as it were, the actual attendants on the occasion,

The lectures of Dr. HUGHES BENNETT have brought thescience of medicine, in reference to its practice, down to thepresent moment. Clinical lectures by BARWELL, CHAMBERS,CRITCHETT, GRAILY HEWITT, ADAMS, FULLER, and the intro-

ductory addresses of Mr. PAGET and Dr. RUSSELL REYNOLDShave illustrated the position of practical medicine and surgeryin most of their branches. The original course of lectures byDr. RADCLIFFE have opened a new field for reflection and

practice in one of the most intricate and difficult class of dis-eases to which the human frame is liable. Mr. HILTON’S lec-

tures "On Rest exhibit the enlarged experience, on an in-teresting physiological subject, of one of the most experiencedand sagacious surgeons of the age-respecting whom it may besaid that, unlike many others, it is to be regretted that he haswritten so little. Medicine and surgery have been further

advanced by the " Mirror" in its reports from all the greathospitals of the metropolis and many of the provincial insti.tutions. The proceedings of the Medical Societies have beenfully and faithfully recorded ; and original communicationshave appeared from physicians and surgeons both in Londonand in the country, forming in the aggregate a mass of in.formation useful to the student, the man of science, and the

busy practitioner.All such retrospects as the present are fraught with some

recollections which occasion regrets. Those we either well

knew, or knew well of, pass away. Our profession has sus-

tained the loss by death of many whose abilities and personalvirtues had secured to them deservedly high positions. We

may particularize the names of H. C. JOHNSON, J. H. POWER,J. SODEN, J. CHALLICE, GOLDING, ILES, MOORE NELIGAN,HOPE, GILBERT, CARR, PRICE, BREWER, ANCELL, EDWARDS,STEPHENS, WEBB, BRAYBROKE, and lastly, that of JOSEPH

HENRY GREEN, whose demise we have so recently recorded.Their memories still remain. For them no higher eulogy needbe awarded than the simple phrase-" they did their duty,’’’and bore with them to their graves the respect of their profes-sional brethren.

c C 2

734

We bring our labours for the year to a close. Now, whenthe recollections of the past have necessarily recurred to ourminds, we become the more firmly impressed with the re-

sponsibilities of a position which enlists us in the service oia science the end and aim of which is human life -life

in all those varied disguises with which disease invests it-life in health and sickness, one and indivisible,-the greatmystery to discover the seat of which philosophers have pinedand died in vain, since our being sprang into existence from thebreath of our creating GoD.

Medical Annotations.

THE CONDEMNED GEORGE VICTOR TOWNLEY.

"Ne quid nimis."

WE are glad to perceive that exertions are being made inbehalf of this unhappy prisoner. The arguments advanced bythe mayor and other magistrates in the town of Derby, in arequisition to Sir George Grey, with the benevolent purposeof trying to prevent the execution of a madman, are those

which we have already urged as grounds for a commission ofinquiry into his present condition. The act was committedwithout premeditation, with a pocket-knife which the prisonerby untoward misfortune had at the time in his possession. Itwas the act, to use the expression of Mr. Justice Williams onthe trial of Frost, of "a diseased mind"-a mind not thenmad in the common acceptation of the term, but unable, in assne manner, to exercise a control over the actions of the indi-vidual. Those who take a superficial view of such mattersmay argue that the condition of mind such as the prisoner’sconduct then exhibited showed no incapacity for estimating ,,the character and consequences of his dreadful deed. The

reply to such an objection is-he was not then medicallyexamined. All, therefore, that can be said is, that an

individual with an hereditary insanity unmistakably deve-loping itself, having " suffered as much agony of mind asit was possible for any man to suffer" (we quote the observa-tion of the learned judge) suddenly breaks down, and commitsan act at variance with the previous tenor of his whole life,and inexplicable on any assumption of criminality recon-

cilable with sanity. We seek not to argue the subtle questionof how much of disease excuses crime. It is not for us tomeasure the dispensation of Providence which permits diseaseto so prevail. We cannot fathom what feelings, thoughts, orimpulses were thereby produced. In every instance the casemust be considered as a whole. The man is now, it is affirmed,unquestionably a lunatic ; the presumption is that he was sothen, and that the crime was the first overt act of the

developed hereditary taint. Had Dr. Winslow been enabledto state to the jury that at the time of the commission of theact Townley’s mind was in a condition similar to that presentedon the occasion of the examination, there is no doubt that theirverdict would have been different. He did say all that medicalscience permitted, and therefore his opinions as to Townley’spresent state demand attention, and they are positive as to hisexisting mental condition. This is an exceptional case. Weadmit that Townley knew at the time of its commission thecharacter and consequences of his act. Madmen, as madmen, dothe same. We admit that his case then came within the pro-visions of the letter of the law, but we protest against theprovisions of the law being now carried out in reference to anoffender deranged at the time of his trial, four months after thecommission of his offence. If his mind is in the condition

described, he is beyond the reach of human justice. God for-bid that in this Christian country one believed to be mad shouldoe executed while any doubt can be reasonably entertained asto his mental state.

VACANT MEDICAL OFFICES.

By the demise of Mr. Green two important offices have be-come vacant-the Presidency of the General Medical Councilof Education and an Examinership in the Royal College ofSurgeons. It is a matter of vast importance to the welfare ofthe profession that these vacancies should be filled by com-petent persons. With regard to the first there would appearto be one gentleman who is prominently marked out for thehonour. It is to the President of the College of Physicians towhom we refer. But will he be elected ? It has been stronglyasserted that he will. From information, however, which we pos-sess, we are inclined to the opinion that it is by no means certain.An influential section, if not a majority, of the Council are not infavour of this selection. It is positively stated that their choicehas fallen upon Dr. George Burrows. A very short time will besufficient to determine this question. The post is one of greatresponsibility, particularly in respect to the course which theCouncil may be advised to pursue in regard to the increasedpowers for which it is about to apply to Parliament. The

Council may be said to be upon its trial. Its exertions in the

cause of the profession have been far from satisfactory to thegreat body of its constituents. It would be unjust to saythat it has not accomplished some good, but so much re-mains to be done that the appointment of the future Presidentwill be looked forward to with anxiety on the part of thosemore immediately interested. The Court of Examiners of the

Royal College of Surgeons, though containing a majority of gen-tlemen fully competent to exercise that important function, isnot altogether such as might be wished. The principle whichhas hitherto mainly prevailed in the selection of Examiners bytheir seniority in the Council is open to grave and serious

objections. These have not been without their weight on theCouncil on more than one occasion. It is earnestly to be desiredthat the governing body of the College should select for thepresent vacancy a gentleman who will meet with generalapproval.

AN IMPROVED HOSPITAL.

OUR indefatigable contemporary, the Builder, has been

making a sanitary tour through Buckinghamshire, as part ofits plan for a general review of the condition of the agriculturaldistricts. Our fellow-labourer really performs his hygienicduties so admirably, that we are half inclined to cry outfor him to enter the profession, and not to hang on as an

"outsider." We appreciate his work so highly that we aretempted to glean from it the following information respectingAylesbury, as it may be interesting to our readers, Aylesbury,we are told, is a pleasant little town, and might, if all were

rightly managed, become one of the most healthy spots inEngland. Good sanitary measures, it is probable, would re-duce its death-rate to about nineteen or twenty in the thousand :at present it is about twenty-five. The new Infirmary is saidto have an excellent site: on all sides are pleasant views, andthe air is bracing and healthy. The wards are lighted fromeither side, and at each end a large circular-headed windowaffords the opportunity of a fine view over the adjacentcountry. The ceiling and walls throughout the building areof Parian cement, which is polished as bright as marble; thefloor is of polished oak, and all the furniture is of the same

material; so that there can be but little risk of the ab-

sorption of impurities, as was the case in the last AylesburyHospital, and so markedly (for instance) in the old DreadraouglttHospital Ship on the Thames, which was saturated with thefomites of erysipelas. No cooking of any kind is allowed inthe wards ; and the closets are so arranged that contaminationof the atmosphere of the wards can scarcely happen. Thewalls of the wards are of a delicate rose colour, which is cheer-ful to the eye. There is an allowance of 1500 cubic feet toeach patient. In the Surrey County Prison each cell containsS19 cubic feet; in the Knutsford House of Correction, 910